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Do We Have a Winner? Gamification in Healthcare

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One of the trends sweeping the healthcare app world is gamification, using game-thinking and game-mechanics to change behavior.

The basic idea is to reward players for accomplishing desired tasks. It may also take advantage of natural competitive tendencies, pitting players against each other or a standard metric.

“Gamification is fundamentally a tool for motivation. In healthcare, it’s primarily useful for behavior change – helping people commit to and stick with activities they know they want to do,” professor Kevin Werbach told HealthBiz Decoded.

“That could be exercising more, taking your medication regularly, or, in the case of the app SuperBetter, taking a series of steps associated with better recovery from serious illnesses,” said Werbach, author of For the Win: How Game Thinking Can Revolutionize Your Business.

SuperBetter is a “tool for self improvement” that can tackle a number of big goals, like recovering from an injury, eating better or losing weight. The app keeps track of a user’s “Quests” and lays out daily and weekly to-dos aimed at making changes a little bit at a time.

“Gamification can be used in virtually any industry, but solutions need to be tailored to the particular challenge,” Werbach said.

Games and healthcare are a natural fit, says gamification expert Gabe Zichermann.

“Fundamentally people are bad at one very specific thing: deferring pleasure now for future gain and avoidance of pain,” Zichermann told HealthBiz Decoded.

Often the right or “healthy” decision is to make a sacrifice now for the good of later, but people aren’t naturally inclined to do that. Not exercising and eating junk food feels good in the moment but can have costly repercussions.

That’s where gamification comes in.

“Games are designed to help raise people’s engagement now in a way that’s more powerful than what we’ve had before,” said Zichermann, public speaker, entrepreneur and author of The Gamification Revolution.

Games where users earn badges, points or other rewards for good choices can help battle preventable health issues, he said.

Positive reinforcement has proven to be more effective than negative in gaming healthcare apps, he said. As an example, Zichermann mentioned Stickk, an app designed to help commit to a goal, such as quitting smoking. In that case, Stickk users enter their credit card information at the start and have to pay every time they smoke.

But that model failed, he said, because it was negative reinforcement and users invariably cheat the system, in this case they just don’t tell the app that they had a cigarette. Studies have shown that incentivizing drug adherence by paying users doesn’t work, because people cheat the system.

Games can be used to motivate people to generally take better care of themselves, like SuperBetter, or specifically to improve fitness, like Nike+ or Fitocracy, or for managing chronic illnesses.

MySugr, described as a “charming and cheeky diabetes manager,” helps users track blood glucose levels, carbohydrate intake, basal body temperature and activity levels. A user who’s diligent with logging info is rewarded with feedback from the app.

Other successful examples, according to Werbach, include Keas, which uses gamification to motivate employees at large enterprises to engage in health and wellness activities, and Hope Labs, which has shown a 60 percent increase in physical activity among low-income kids using a device similar to Nike+ called Zamzee, with a gamification service built around it.

The technique has been most successful in apps encouraging people to run more, in diabetes management and with children, who respond particular well to games, Zichermann said.

Gamification has also shown promise on the provider side, Zichermann notes. Published in 2007, the Top Gun study at Beth Israel hospital in New York found that surgeons who played video games performed better at laparoscopic surgery, which is a screen-mediated process. That study suggested games should be used as a practical teaching tool for training surgeons.

According to research firm Gartner, gamification can be used to develop skills, change behaviors and enable innovation, all essential to the healthcare industry. But it also faces challenges.

Gamification may be at the peak of hype right now, and could be setting up businesses with unrealistic expectations of success, according to Brian Burke of Gartner. He predicts that by 2014, 80 percent of gamified apps will fail to meet business expectations due to poor design.

To be successful, businesses must evaluate their objectives and see how gamification can help, treat the audience as players not puppets, and make player goals and business objectives overlap, Burke wrote.

Zicherman believes there won’t be one “magic bullet” game to solve all of the problems in healthcare, but games can break down big problems into smaller chunks, and those small steps can move the needle.

From a game design perspective, users need to be motivated to play because they want to, not because you want them to, and it has to stay interesting for them.

“Gamification is more a process than a product, something we do long term to get results,” he said. “Businesses are investing more and more money in this.”

Game mechanics have been used in military pursuits for thousands of years, Zicherman said, “but today’s availability of iPhones, tablets and social graphs like Facebook makes it exponentially more possible to utilize.” There’s no doubt that healthcare apps and provider tools will prove winners, but it will take time.

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